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Community Access Pharmacy: Patient Care Services

Written by Dr. Sally Haack PharmD.

The Community Access Pharmacy provides disease state education in the areas of diabetes, hypertension, and hyperlipidemia, with the opportunity to add asthma in the near future. These patient care services have been generated by grant funding and continued, with modifications, after the grants have ceased.

The diabetes-focused grant, which concentrated on providing education and monitoring to CAP patients, was funded by the Wellmark Foundation. Patients were referred to the pharmacy by their providers at Primary Health Care. Both English and Spanish-speaking patients were enrolled. The patients needed to meet certain criteria in order to be eligible. They had to be an adult with type 2 diabetes and been newly diagnosed or poorly controlled (HgbA1c > 8%). Fifty patients were enrolled in the program.

The diabetes project provided patients with a free glucometer, test strips, and lancets for six months. In return, patients were expected to return to the pharmacy on a monthly basis for appointments. The patients were educated on how to use the glucometer and also participated in 2 classes. The classes were Fundamentals of Diabetes Education and Basic Dietary Education. Each class consisted of a small group of 2-4 patients, which gave them the chance to ask questions and raise concerns. The patients’ glucometers were downloaded at the monthly appointments. The pharmacist and pharmacy rotation student followed up on drug therapy problems, encouraged patients in lifestyle changes, and answered questions regarding self- care. These services have shown to improve patients’ health. Outcomes Pharmaceutical Health Care tracked patient progress by different clinical indicators throughout the project. HgbA1c’s decreased by two percent on average (2%) and patients and providers were both satisfied with the diabetes care.

Even though enrollment for the diabetes project stopped in May, CAP has continued to provide these services to patients. The test strips and lancets are no longer free for patients, but the education is still available. Patients stop in for scheduled monthly appointments. The duration of the program for each patient is not six months, as it was in the grant project. Instead, it is based on patient interest and is available as long as the patient keeps scheduling appointments. A progress note is sent to the patients’ providers after each meeting to update them on any trends in glycemic control and to make recommendations regarding drug therapy. CAP has trained approximately 70 patients since May and has followed-up with many of them with the goal of improving their diabetes outcomes.

The hypertension and hyperlipidemia services at CAP have also transformed over the past year. Drake’s ASP (Academy of Student Pharmacists) chapter began a program that focused on medication adherence. Along with providing ideas on improving compliance, they also incorporated disease state education sections for hypertension and hyperlipidemia. Patients volunteered for this program after it was marketed in the pharmacy. The series of four appointments helped patients understand their condition and also gave the pharmacy students the opportunity to monitor labs in the pharmacy. They used a Cholestech machine to check lipid profiles and also measured blood pressure, if patients agreed.

The ASP students are no longer involved in these services at CAP, but the pharmacy has been re- working the project to expand it in the next few months. In addition to hypertension and hyperlipidemia, asthma will also be added. While medication adherence will remain a component of the project, it will not be the main focus. Pharmacy students and pharmacists will work together with patients to reach their goals by providing more regularly scheduled follow-ups at the pharmacy. Asthmatic patients, for example, will be able to bring in their asthma daily diary to discuss their symptoms, triggers, and peak flow readings. This will help improve the patients’ understand of their disease state and how to control it more effectively.